Clinical Presentation An 18-year-old White male had multiple subcutaneous rheumatoid nodules over his left elbow. He complained about pain and discomfort in the area and agreed to surgical resection to remove the subcutaneous lesions. Because of the large area affected, a large soft tissue defect was anticipated after surgical resection for these lesions ( Fig. 17.1 ). Operative Plan and Special Considerations Based on the size and…

Clinical Presentation A 55-year-old White female had residual sarcoma over her left upper arm after previous resection. She underwent a wide local excision of the sarcoma by the surgical oncology service. The plastic surgery service was asked to perform a soft tissue reconstruction after additional resection of residual sarcome. After the wide local excision, there was an 11 × 8 cm full-thickness skin and subcutaneous tissue defect down…

Clinical Presentation A 67-year-old White male had a chronic wound in the right axilla secondary to previous radiation for treatment of his advanced metastatic lung cancer. He had responded incredibly well to chemotherapy for his lung cancer and had been cancer-free since the completion of the last chemotherapy. The patient was referred by his medical oncologist for possible closure of this longstanding wound in his right…

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Clinical Presentation A 52-year-old White male underwent C4–C7 posterior cervical fusion 4 months previously. He was discharged home and subsequently had wound dehiscence and drainage from his neck wound. He was seen in outpatients by the orthopedic spine service and was admitted to the hospital directly for debridement, intravenous antibiotic treatment, and definitive wound closure. The plastic surgery service was consulted for this complex wound closure and…

Clinical Presentation An 89-year-old White male developed a recurrent squamous cell cancer (SCC) over his right upper lateral neck with a large, ulcerated lesion. He had an SCC resection in the same area many years before. The patient was referred by the surgical oncology service for soft tissue reconstruction after a planned wide local excision of this recurrent SCC lesion. He also had a planned postoperative…

Clinical Presentation A 30-year-old White female sustained severe neck contracture from a previous burn injury about 5 years ago. She had excision of the deep burn wound and skin grafting in a local hospital but unfortunately developed severe anterior neck scar contracture ( Fig. 11.1 ). She reported severe limitation of the range of motion (ROM) in her neck especially neck extension and requested a surgical release…

Case 1 Clinical Presentation An 18-year-old man fell off a moving vehicle and was then struck by the same vehicle. He was intubated and was in critical condition. Initial injuries included an open skull fracture with exposed intracranial contents, scalp avulsion, left-sided facial avulsion, left superior and lateral orbital wall fractures, bilateral sphenoid sinus fractures, bilateral temporomandibular joint fractures with extension into the intraarticular space on…

Case 1 Clinical Presentation A 58-year-old White female had a 4 × 4 cm skin lesion of cancerous appearance above her central lower lip ( Fig. 9.1 ). She underwent a local excision of the lower lip lesion with a 5-mm margin by the plastic surgery service ( Fig. 9.2 ). All peripheral and deep margins were confirmed negative for basal cell carcinoma, a tissue diagnosis in the operating room,…

Clinical Presentation A 58-year-old White female sustained a dog bite to her nasal tip. Apparently, she lost a significant amount of nasal tip cartilage and also had a sizable nasal skin defect. After a period of local wound care, the nasal skin wound healed ( Figs. 8.1 and 8.2 ). She desired appropriate reconstruction for the partial composite defect of her nose and was brought to the…

Case 1 Clinical Presentation A 24-year-old Hispanic male sustained a human bite on his right ear. He had a partial ear amputation involving the helical rim and a small portion of antihelix as well as their overlying skin ( Figs. 7.1 and 7.2 ). He was initially treated for the local wound and the open wound over his ear healed afterward ( Fig. 7.3 ). Appropriate reconstruction for…

Clinical Presentation A 77-year-old White female sustained necrotizing fasciitis in her right periorbital area secondary to facial trauma. She was initially seen by an oculoplastic surgeon and urgently referred to the plastic surgery service for more definitive surgical management. On clinical examination, she had a periorbital soft tissue infection involving both upper and lower eyelids. She was urgently taken to the operating room for surgical debridement…

Clinical Presentation A 40-year-old White male had previously sustained a gunshot wound to his mandible and left mandibular bony reconstruction was unsuccessful. He had a significant deformity of his left lower face and desired a “good” mandibular reconstruction, not only to improve his lower face contour and deformity but also to have possible future reconstruction for osteointegrated dental implants ( Figs. 5.1 and 5.2 ). A preoperative…

Case 1 Clinical Presentation A 19-year-old White male with right alveolar squamous cell carcinoma (SCC) of the mandible underwent local surgical excision of the alveolar edge and the floor of the mouth and a marginal mandibulectomy via a lower lip split approach as well as a right modified neck lymph node dissection by the surgical oncology service ( Fig. 4.1 ). Intraoperative frozen sections of the peripheral…

Case 1 Clinical Presentation A 51-year-old White male had a basal cell cancer over his left medial cheek and nasal sidewall. Mohs surgery was performed by our dermatological surgeon and the skin resection margins were all negative. The patient had a 6 × 2.5 cm skin defect involving the medial cheek and nasal sidewall near the medial canthus ( Fig. 3.1 ). The plastic surgery service was asked to…

Clinical Presentation A 52-year-old White male had a “large” melanoma in the right temporal area ( Fig. 2.1 ) and underwent a wide local excision of the temporal melanoma with a 2-cm margin and sentinel lymph node biopsy in the face and neck by the surgical oncology service. He had a 4.5 × 4.5 cm skin defect down to the superficial temporal fascia involving the upper face, temporal area,…

Case 1 Clinical Presentation An 85-year-old White male with recurrent squamous cell carcinoma of his central scalp underwent additional surgical excision of the scalp including deep margin by the surgical oncology service. Once the peripheral and deep margin assessments by intraoperative frozen sections confirmed cancer was not present, the patient had a 10 × 7 cm full-thickness scalp defect with exposed skull. In the central part of the…